Effective environmental public health surveillance programs: A framework for identifying and evaluating data resources and indicators

The complexity and multidisciplinary nature of environmental public health (EPH) surveillance call for a systematic framework and a concrete set of criteria to guide development, selection, and evaluation of environmental public health indicators. Environmental public health indicators are the foundation of a comprehensive EPH surveillance system, providing quantitative summary measures and descriptive information about spatial and temporal trends of hazard, exposure, and health effects over person, place, and time. A case-synthesis review of environmental regulatory and public health indicator models was employed to develop a framework and outline a methodological approach to EPH surveillance system development, including the selection of content areas and the corresponding data and environmental public health indicators. The framework is organized around three assessment phases: (1) scientific basis and relevance, (2) analytic soundness, and (3) feasibility, interpretation and utility. By outlining a process and identifying important constructs and criteria, the framework provides practitioners with an effective and systematic tool for making scientifically valid programmatic decisions about EPH content development. Improved decision making ensures more effective EPH surveillance systems and enhanced opportunities to understand and protect the public health from environmental threats.